BMC Anesthesiology最新文献

{"title":"Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study.","authors":"Ahmet Murat Yayik, Elif Oral Ahiskalioglu, Erkan Cem Celik, Mirac Selcen Ozkal Yalin, Binali Firinci, Irem Ates, Muhammed Enes Aydin, Ali Ahiskalioglu","doi":"10.1186/s12871-025-03007-z","DOIUrl":"10.1186/s12871-025-03007-z","url":null,"abstract":"<p><strong>Introduction: </strong>Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region.</p><p><strong>Method: </strong>Children aged 1-7, ASA I-II were included in this study. The patient population was assigned into two groups as the Caudal Block Group (Group CB) and the Control Group (Group C) Caudal block with 0.25% bupivacaine 1 ml/kg was performed on patients in Group CB. Optic nerve sheath diameter was measured at the following timeline: T₀: Following laryngeal mask placement, T₁: Following caudal block. T₁₅:15. min, T₃₀:30. min. Heart rate, non-invasive blood pressure, SpO₂ and PCO₂ values were also recorded at every time point.</p><p><strong>Results: </strong>There was no significant difference between two groups considering demographic data, intraoperative hemodynamic parameters, intraoperative SpO₂ and PCO₂ values. While optic nerve sheath diameter findings were not significantly different between the groups at T0 and T1 points(P > 0.05), the measurements at T15(4.18 ± 0.56 for Group C and 4.62 ± 0.47 for Group CB, P = 0.006) and T30(4.20 ± 0.53 for Group C and 4.76 ± 0.52 for Group CB) were statistically higher in the Caudal Group.</p><p><strong>Conclusion: </strong>Evaluation of optic nerve sheath diameter has high diagnostic precision for detecting increased intracranial pressure in children. The findings in this study display that local anesthetic applied for caudal block in pediatric surgeries spread cranially resulting in an increase in the intracranial pressure and optic nerve sheath diameter. However, this increase does not cause intraoperative hemodynamic changes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"138"},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexamethasone vs. placebo modulation of the perioperative blood immune proteome in patients undergoing total knee arthroplasty.","authors":"Asger K Mølgaard, Kasper S Gasbjerg, Ole Mathiesen, Daniel Hägi-Pedersen, Ismail Gögenur","doi":"10.1186/s12871-025-03003-3","DOIUrl":"10.1186/s12871-025-03003-3","url":null,"abstract":"<p><strong>Background: </strong>Pre- and post-operative immune status has gained interest in recent years, as it has been shown to be related to postoperative complications and recovery. The change in immune status has also been known to constitute a large part of the surgical stress response, and it has been speculated that immunomodulatory treatment by glucocorticoids may impact it. Profiling of the impact of specific surgeries and medications on immune status are therefore needed.</p><p><strong>Methods: </strong>We characterized the postoperative blood immune proteome in 83 patients receiving either placebo (n = 20) or IV 24 mg dexamethasone (n = 60) preoperative before total knee arthroplasty (TKA). The primary outcome was the effect of dexamethasone on total knee arthroplasty surgical stress by comparing postoperative immune proteome in the dexamethasone group and the placebo group. Secondary outcomes were the surgical stress by total knee arthroplasty by comparing pre- to postoperative immune proteome in the placebo group, and the combined effect of surgical stress and dexamethasone by comparing pre- to postoperative immune proteome in the dexamethasone group. Characterization was performed with the Olink Explorer Inflammation panel on blood samples from the biobank for future research collected during the randomized, clinical DEX-2-TKA Trial. Protein change was reported as log2-fold-change and p-values were corrected a.m. Benjamini-Hochberg.</p><p><strong>Results: </strong>The surgical stress (placebo) was characterized by a 4.7 log2-fold-change of IL6 (adjusted p-value < 0.01) and up-regulation of central immune signaling pathways and bone marrow mobilization. The combined effect of surgery and dexamethasone showed a less pro-inflammatory profile: IL6 2.5 log2-fold-change (adjusted p-value < 0.01), with decreased signaling for osteoclast activity and innate, immune cell reaction. The effect of dexamethasone showed upregulation of CSF3 (1.55 log2-fold-change, adjusted p-value < 0.01) and an inhibitory effect on both innate and adaptive immune response, immune cell reactivity and formation of extracellular matrix.</p><p><strong>Conclusions: </strong>Preoperative dexamethasone indicated anti-inflammatory properties on both innate and adaptive immune response, while surgery was pro-inflammatory. the combination of total knee arthroplasty and dexamethasone inhibited pathways for osteoclast-activity, indicating possible implications on aseptic prosthesis loosening. Dexamethasone showed strong modulation of the surgical stress response following total knee arthroplasty and future studies must explore the clinical associations of these findings.</p><p><strong>Trial registration: </strong>NCT03506789.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"136"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of lung ultrasound for locating bronchial blockers in pediatric thoracic surgery: a retrospective analysis.","authors":"Weiwei Cai, Yuting Song, Wei Gu, Huanhuan Ni, Huiying Shao, Hongqiang Huang","doi":"10.1186/s12871-025-03006-0","DOIUrl":"10.1186/s12871-025-03006-0","url":null,"abstract":"<p><strong>Objective: </strong>To identify the feasibility of using lung ultrasound to determine the position of bronchial blockers in pediatric patients.</p><p><strong>Methods: </strong>In this study, children aged 4-8 years who underwent elective right one-lung ventilation at our hospital between January 2019 and August 2022 were selected. We collected the results of lung ultrasound and fiberoptic bronchoscopy during the placement of bronchial blockers in these children. The accuracy, sensitivity, and specificity of lung ultrasound in determining the position of bronchial blockers were calculated. Additionally, the reproducibility of lung ultrasound in determining the appropriateness of bronchial blockers was also calculated. Furthermore, information regarding whether there were complications associated with lung ultrasound examination or fiberoptic bronchoscopy was also collected.</p><p><strong>Results: </strong>The accuracy of lung ultrasound for determining the position of bronchial blockers was 95.0%. When the position of BBs was appropriate, the sensitivity of lung ultrasound was 96.3% and the specificity was 88.9%. When the position of BBs was too shallow, the sensitivity of lung ultrasound was 75% and the specificity was 96.7%. The reproducibility test of lung ultrasound for determining the position of bronchial blockers had a weighted kappa value of 0.91, P < 0.001. In this study we found 6 children had hypoxemia and 6 children had airway mucosal bleeding during fiberoptic bronchoscopy. And no complications linked to lung ultrasound examination were observed.</p><p><strong>Conclusion: </strong>Lung ultrasound has high accuracy, sensitivity, specificity, and repeatability in determining the position of bronchial blockers. It is a new and safe method to determine the position of bronchial blockers.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"137"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of lidocaine via trachospray in postoperative sore throat and hemodynamic response to intubation: a randomized controlled trial.","authors":"Kübra Taşkın, Fatih Doğu Geyik, Gülten Arslan, Özlem Sezen, Banu Çevik","doi":"10.1186/s12871-025-03004-2","DOIUrl":"10.1186/s12871-025-03004-2","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sore throat (POST) is a common complication following endotracheal intubation after general anesthesia. This study aimed to examine the effect of administering lidocaine via the Trachospray device on POST severity and to assess its impact on hemodynamic responses (heart rate and blood pressure) during tracheal intubation.</p><p><strong>Methods: </strong>In a double-blind, randomized controlled trial was conducted, approved by the local ethics committee and registered on ClinicalTrials.gov. 100 patients aged 18-65 undergoing elective laparoscopic cholecystectomy and classified as ASA I-III were randomly divided into two groups. Group T received 10% lidocaine through Trachospray before intubation, while Group S was given distilled water. POST severity was evaluated at 2, 6, 12, and 24 h postoperatively. POST was evaluated on a 4-point scale, with scores of 0 (none) to 3 (severe).</p><p><strong>Results: </strong>Group T showed significantly lower POST severity and incidence at all time points compared to Group S (p = 0.001; p < 0.05). Additionally, hemodynamic responses (heart rate and blood pressure) were significantly lower in Group T following intubation (heart rate, p = 0.015; systolic blood pressure, p = 0.006; diastolic blood pressure, p = 0.010).</p><p><strong>Conclusion: </strong>The use of 10% lidocaine via Trachospray before endotracheal intubation effectively decreases POST severity and incidence as well as the hemodynamic response to intubation, highlighting its potential to improve patient outcomes in the postoperative period.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"133"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postoperative nausea and vomiting using machine learning: a model development and validation study.","authors":"Maxim Glebov, Teddy Lazebnik, Maksim Katsin, Boris Orkin, Haim Berkenstadt, Svetlana Bunimovich-Mendrazitsky","doi":"10.1186/s12871-025-02987-2","DOIUrl":"10.1186/s12871-025-02987-2","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) is a frequently observed complication in patients undergoing surgery under general anesthesia. Moreover, it is a frequent cause of distress and dissatisfaction in the early postoperative period. Currently, the classical scores used for predicting PONV have not yielded satisfactory results. Therefore, prognostic models for the prediction of early and delayed PONV were developed in this study to achieve satisfactory predictive performance.</p><p><strong>Methods: </strong>The retrospective data of inpatient adult patients admitted to the post-anesthesia care unit after undergoing surgical procedures under general anesthesia at the Sheba Medical Center, Israel, between September 1, 2018, and September 1, 2023, were used in this study. An ensemble model of machine-learning algorithms trained on the data of 35,003 patients was developed. The k-fold cross-validation method was used followed by splitting the data to train and test sets that optimally preserve the sociodemographic features of the patients.</p><p><strong>Results: </strong>Among the 35,003 patients, early and delayed PONV were observed in 1,340 (3.82%) and 6,582 (18.80%) patients, respectively. The proposed PONV prediction models correctly predicted early and delayed PONV in 83.6% and 74.8% of cases, respectively, outperforming the second-best PONV prediction score (Koivuranta score) by 13.0% and 10.4%, respectively. Feature importance analysis revealed that the performance of the proposed prediction tools aligned with previous clinical knowledge, indicating their utility.</p><p><strong>Conclusions: </strong>The machine learning-based models developed in this study enabled improved PONV prediction, thereby facilitating personalized care and improved patient outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"135"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia for bronchoscopy interventional therapy in a patient with Gorham-Stout disease, lung cancer, and right lung atelectasis: a case report.","authors":"Yuxue Yao, Hong Li, Qinghao Cheng, Mingyuan Yang","doi":"10.1186/s12871-025-03001-5","DOIUrl":"10.1186/s12871-025-03001-5","url":null,"abstract":"<p><strong>Background: </strong>Gorham-Stout disease (GSD) is an extremely rare disease of unknown etiology, characterized by painless and progressive bone resorption that may affect multiple bones throughout the body. GSD primarily involves the maxillofacial region, leading to facial disfigurement and reduced joint stability, thereby increasing the risk of challenging tracheal intubation. Limited cases have been reported on the co-occurrence of GSD in the maxillofacial region with lung cancer and right lung atelectasis, particularly regarding anesthesia management for bronchoscopy interventional therapy in such patients.</p><p><strong>Case presentation: </strong>This report presents a successful case of a patient with maxillary GSD and right lung atelectasis secondary to lung cancer who underwent bronchoscopy interventional therapy under general anesthesia. The perioperative course was uneventful, with no complications observed.</p><p><strong>Conclusion: </strong>Anesthesia management is critical in the surgical treatment of patients with GSD. Airway management poses unique challenges, necessitating thorough preoperative evaluation and implementation of strategies to address potential intubation difficulties. Additionally, vigilance for intraoperative complications is essential.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"132"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory and limb muscles' ability to repeatedly generate maximal isometric strength in patients with intensive care unit-acquired weakness: an observational study.","authors":"Margaux Machefert, Guillaume Prieur, Solène Aubry, Yann Combret, Clément Medrinal","doi":"10.1186/s12871-025-03008-y","DOIUrl":"10.1186/s12871-025-03008-y","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit-acquired weakness (ICU-Aw) is a prevalent complication in critically ill patients, affecting both limb and respiratory muscles, individually or concurrently. The precise mechanisms by which muscle weakness influences the distinct functional roles of each muscle group remain to be fully elucidated. The objective of this study was to compare the time course evolution of inspiratory and quadriceps muscles strength during repeated maximal isometric contractions in patients with limb muscles and inspiratory muscles weakness.</p><p><strong>Methods: </strong>A single-center, observational study was conducted in critically ill patients after extubation, presenting with both inspiratory and limb muscle weakness (defined as maximal inspiratory pressure (Pi_max) < 30 cmH₂O and an MRC score < 48). The patients' ability to sustain maximal voluntary effort was measured using electronic manometers and dynamometers, with repeated efforts performed 10 times. Following each measurement, a 10-second rest period was observed, and strength measurements were repeated to evaluate recovery.</p><p><strong>Results: </strong>A total of 20 patients (90% male, mean age 61 ± 10 years, SAPS II score 28 ± 17) were included. The mean first maximal inspiratory pressure was 32.6 ± 17 cmH₂O, and the mean first quadriceps maximal force was 135 ± 90 Newtons (N). Investigation revealed a decline in quadriceps muscle force of -15.45 ± 28.61 N (95% CI: -28.84 to -2.05) while inspiratory muscles demonstrated stability (mean difference: 1.75 ± 7.57 cmH₂O (95% CI: -1.80 to 5.30)). A statistically significant interaction between time and muscle group was identified (p = 0.0017), suggesting a different time course evolution of maximal voluntary strength between muscle groups. After a one-minute recovery, significant improvement in quadriceps strength was observed (p = 0.009), while no statistically significant change was detected in inspiratory muscle strength (p = 0.16).</p><p><strong>Conclusions: </strong>The results of this study indicate potential disparities in the maximum force maintenance capacity between the quadriceps muscles and inspiratory muscles in patients with ICU-acquired weakness.</p><p><strong>Trial registration: </strong>Registered on ClinicalTrials.gov Identifier NCT05396066.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"134"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midazolam premedication facilitates mask ventilation in children during propofol induction of anesthesia: a randomized clinical trial.","authors":"Rafet Yarimoglu, Betul Basaran, Tayfun Et, Aysegul Bilge, Muhammet Korkusuz","doi":"10.1186/s12871-025-03002-4","DOIUrl":"10.1186/s12871-025-03002-4","url":null,"abstract":"<p><strong>Purpose: </strong>Mask ventilation is the most widely used method to provide ventilation during anesthesia induction. Appropriate head and neck positions, exaggerated jaw lifts, two-hand and two-person ventilation, and the use of oral or nasal airways can facilitate mask ventilation. Neuromuscular blockers and premedication drugs such as midazolam and dexmedetomidine have also been proposed to facilitate mask ventilation. The hypothesis of this study was that midazolam premedication would facilitate mask ventilation in children.</p><p><strong>Methods: </strong>Children aged 2-10 years were randomized into two groups. The midazolam group (Group M) received an intravenous dose of midazolam premedication (0.1 mg/kg, maximum dose 3 mg), and the control group received an intravenous dose of saline of the same volume (Group C). The primary outcome of the study was to examine the effect of midazolam premedication on mask ventilation in children, using the Han mask grading scale.</p><p><strong>Results: </strong>The data of 120 children were analyzed (n = 60 in Group M, n = 60 in Group C). According to the Han mask grading scale, the scores of the patients in the midazolam group were significantly lower than those of the control group. The distribution of Han scores was significantly different between the groups (p < 0.001). In the midazolam group, 93.3% of the children had a Han score of 1 and 6.7% had 2, and in the control group, 60% had a score of 1, and 40% had 2. In the subgroup analysis of overweight children, a Han score of 1 was determined in 91.7% of the midazolam group and 61.1% of the control group (p = 0.03).</p><p><strong>Conclusion: </strong>In conclusion, the results of this clinical research demonstrated that midazolam premedication improves mask ventilation in children during general anesthesia induction. The findings also showed that the effect of midazolam in facilitating mask ventilation was similar in overweight children.</p><p><strong>Clinical trial registration: </strong>The study was registered in clinicaltrials.gov (trial ID: NCT05368441 on 10/05/2022).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"131"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suppressive effects of deep balanced anesthesia on cellular immunity and protein expression: a randomized-controlled pilot study.","authors":"Xuan Duc Nguyen, Audrey Horn, Dania Fischer, Grietje Beck, Cora C Spannenberger, Brice Gaudilliere, Jean-Louis Horn, Hermann-Josef Thierse, Thomas Frietsch","doi":"10.1186/s12871-025-02980-9","DOIUrl":"10.1186/s12871-025-02980-9","url":null,"abstract":"<p><strong>Background: </strong>It is questionable whether or not a short period of deep anesthesia can have long lasting effects on immune suppression.</p><p><strong>Methods: </strong>To analyze specific effects of deep anesthesia on immune modulation, a randomized-controlled, single-blinded study, monocentric, pilot-study was conducted at a level 1 orthopedic and trauma center. Inclusion criteria were patients scheduled for extended shoulder surgery with an ASA score between 1 to 3 (n = 186). Patients on immune modulating drugs or with immune deficits were excluded. The remaining patients were enrolled and randomized to either deep or light anesthesia (n = 18). Patient were randomized to receive either deep anesthesia or light anesthesia for 60 min or longer. The primary aim of the study was to compare cellular activity of T-cells, NK-cells and monocytes after anesthesia. Phagocytosis and cellular lysis activity of neutrophils and monocytes were analyzed by flow cytometry. Secondly, we analyzed anesthesia induced protein expresssion pattern in human monocytes by a standardized proteomic approach, implicating quantitative two-dimensional (2D) differential gel electrophoresis and Delta2D software analyses coupled with matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) and Mascot analysis.</p><p><strong>Results: </strong>Anesthesia duration was 109 min in the deep anesthesia group with 81 ± 17 min of BIS < 45 and a mean BIS of 38 ± 14. The light anesthesia group received anesthesia for 111 min with 13 ± 8 min of BIS < 45 and a mean BIS 56 ± 8. Cytotoxic T-cells decreased fivefold in the light anesthesia group compared to the deep anesthesia group (-28 ± 13% vs. -6 ± 18%, respectively). The number of NK-cells (p = 0.0127) and regulatory T-cells (p = 0.0217) both dropped after deep anesthesia to almost half of the plasma level. Phagocytosis activity of neutrophils and monocytes was constant with a 67% decreased trend of intracellular lysis in monocytes (p = 0.0625). Quantitative proteomic analyses revealed 27 anesthesia-regulated protein spots in human monocytes, 14 of which were significantly identified by MALDI-MS, and were related to processes such as macrophage function and lymphocyte proliferation, tumor progression and apoptosis.</p><p><strong>Conclusions: </strong>Deep anesthesia inhibited immune competent defense cells (killer cells and regulatory T-cells) and had a general suppression on the phagocytic function of all circulating immune competent cells.</p><p><strong>Trial registration: </strong>Clinicaltrial.gov identifier: NCT02794896.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"129"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of perioperative dexmedetomidine on long-term outcomes in older patients following cardiac surgery: follow-up of a randomized trial.","authors":"Hong Hong, Xue Li, Jing Yang, Yan Zhang, Guang-Yu Liu, Fu-Xia Yan, Dong-Xin Wang","doi":"10.1186/s12871-025-02963-w","DOIUrl":"10.1186/s12871-025-02963-w","url":null,"abstract":"<p><strong>Background: </strong>Perioperative dexmedetomidine is reported to reduce complications and even in-hospital mortality after cardiac surgery. We therefore tested the hypothesis that perioperative dexmedetomidine may improve long-term outcomes after cardiac surgery.</p><p><strong>Methods: </strong>This was long-term follow-up of a randomized trial. We enrolled 285 patients aged 60 years or older who were scheduled for elective cardiac surgery. Patients were randomized to receive either dexmedetomidine or placebo (normal saline) during and early after surgery. Follow-up was conducted for up to 6 years post-surgery. The primary endpoint was overall survival. Secondary outcomes included major adverse cardiovascular events (MACE)-free and hospital-free survivals, as well as cognitive function and quality of life in 6-year survivors.</p><p><strong>Results: </strong>All 285 patients were included in final analysis. Median follow-up duration was 80 months (interquartile range 30 to 80). Overall survival did not differ between the two groups: there were 18 deaths (12.6%) with placebo versus 22 deaths (15.5%) with dexmedetomidine; hazard ratio (HR) 1.22, 95% CI 0.65 to 2.27, p = 0.418. MACE-free survival was 23 (16.1%) with placebo versus 24 (16.9%) with dexmedetomidine; HR 1.03, 95% CI 0.58 to 1.83, P = 0.911. Hospital-free survival was 39 (27.3%) with placebo versus 42 (29.6%) with dexmedetomidine; HR 1.04, 95% CI 0.67 to 1.61, P = 0.853. Among 6-year survivors, the scores of cognitive function and quality of life were similar between groups.</p><p><strong>Conclusions: </strong>We found that, for older patients undergoing elective cardiac surgery, dexmedetomidine administered during and early after surgery did not alter overall and MACE-free survivals, as well as long-term cognitive function and quality of life. However, considering the underpowered sample size and non-negligible loss to follow-up rate, our results need further confirmation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT03289325 (September 20, 2017).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"130"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}